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Individual
TIMOTHY STEVEN WOOTTEN
Active
Individual
TIMOTHY STEVEN WOOTTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA16581
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PA165810
BLUE SHIELD
CA
05
—
0PA165810
—
CA
Enumeration date
11/04/2005
Last updated
08/21/2014
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